By Dr Gill MacLeod at Rood Lane Medical Group

With sickness absence rates up in 2003 for the first time in five years and average cost per employee running at £475 equivalent to a national cost of £11.6 billion; absence management is one of the biggest issues facing companies and it is on everyone’s lips as a problem to be tackled.

In a city environment a factor of x2 or x3 can be applied to the direct costs because salaries are above national averages and in addition there are huge indirect costs:

• Management and HR time (and frustration)
• Disruption to work
• Temporary staff
• Permanent Health Insurance (PHI) premiums (which are rising at a meteoric rate)
• Litigation for stress and other work related health problems

It is widely accepted that up to a third of absence is avoidable, the potential savings are tremendous. So how does an organisation achieve this?

The answer lies in a system to help management separate genuine health problems from “bad behaviour” and putting employers in a position to tackle the people who take excess time off for trivial ailments in a consistent way.

The way to achieve this is through simple reporting procedures and analysis of absence patterns to identify where the problem cases lie. These then need to be sorted into those needing medical or benefit intervention and those which the employer can treat as a clear management matter.

There are a few factors to consider which are laid out below:

1. The number of episodes of illness and the length of each episode. (the Bradford Score – episodes2 x total number of days e.g. eight episodes of one or two days score 82 x 12 = 768, compared with one episode of 12 days 12 x 12 = 12).
2. The nature of the illness. A standard post operative recovery period of six weeks requires no intervention whereas even a few days with “stress” or depression may indicate a serious long term problem, particularly if not dealt with early.
3. The history and general health of the employee. An individual with a specific problem for example. MS or ulcerative colitis may have intermittent periods of illness and a report from the treating doctor may be all that is needed to plan cover at work.
4. Other factors such as deteriorating performance may indicate another underlying problem such as alcohol abuse, of which absence is a symptom.
5. Patterns of absence within a specific area or department may indicate additional issues including poor motivation or management difficulties.

An Occupational Health (OH) Team is in the ideal position to assess the illnesses, the employment requirements and the interaction between the two.

The business then needs clear policies on how to address the problems swiftly and consistently. This sends out strong messages to employees which have a salutary effect of their own!

Once management cases are flagged the manager needs to be pleasant but firm, I strongly advocate the WARM approach. It gets the message across without alienating the employee (which would make things worse and draw up “battle lines”)

W: Welcome them back

• Create a non-threatening and supportive atmosphere


A: Discuss absence

• Explore reasons for the absence and what really caused it; ask in an understanding way why the employee was absent and listen courteously

• Place the absence in the context of previous absences and where appropriate, seek an explanation for any apparent trends or patterns

• Discuss the effect of the absence on others in the department

• Avoid confrontation and stick to facts

• Investigate work overload or underload, personal or other problems


R: The responsibility phase
This has the greatest influence on preventing the problem from recurring

• It may not be their fault but it is their problem; it is not the employer’s problem

• In some cases where attendance is normally not a problem, you can move on

• In other cases, you may need to ask the employee what they are going to do about improving their attendance; agree priorities for the post-absence period

• You need to ask for their commitment to any improvement; if an employee has a problem that is going to cause persistent absence, you must address it


M: Move on

• End the meeting on an upbeat note; express confidence in the employee’s ability to attend in future. Brief the employee on events that occurred during their absence

It is always more effective to work with rather than against the employee whilst still encouraging them to recognise that this is a contract of employment and the problem lies with them. Ultimately if this fails the disciplinary route is appropriate having first ensured that there is no ongoing health problem. This is where good OH is invaluable.

Don’t forget that tracking absence is essential to managing it. In addition it is something the Health and Safety Executive considers best practice.

Managing longer term absence

All longer term absence needs to be evaluated specifically with a view to any potential PHI claim and to early active management and rehabilitation. It is far more difficult to resolve problems that have become established over months than it is to improve chances of recovery in the early stages.

This is particularly true of problems including repetitive strain injury (RSI), chronic fatigue syndrome (ME), psychological disorders and back pain which are some of the conditions where duration of symptoms has a major impact on prognosis.

Early assessment is essential to ensure that the employee is receiving mainstream optimal treatment and that a prompt referral has been made to an appropriate specialist.

1. Any absence in excess of two weeks should be evaluated
2. Unless the absence is well explained and self limiting the employee should be assessed by your occupational health department or provider
3. In cases where the likelihood of longer term sickness is identified, consent for access to medical records should be obtained and reports sought
4. A policy of active medical management and rehabilitation should be pursued in co-operation with the employees own doctors
5. PHI insurers should be notified of a potential claim after three months absence
6. After four months relevant documentation, a claim should be prepared
7. Throughout this period there should be a positive approach to rehabilitation and good communication both with the employee and with any doctors involved in their care

Effective early management of problems can have a significant impact on cost. Sickness absence is expensive and damaging to efficiency. Active management can reduce the cost both in terms of salary and the impact on other staff.

A clear process for managing longer term sickness can help the employee get back to work and affect long term disability claims experience and premiums. A proposed plan of action should be formulated and agreed with the Human Resource Department, the manager and the employee to facilitate better attendance or a return to work as appropriate.

This may include specific rehabilitation measures and a graduated plan for return to work particularly after prolonged illness.

Early identification and intervention together with an integrated approach are the strategies most likely to achieve good results both for employer and employee.